Good content! I like the comparison between the American and Australian guidelines. It would be interesting to know why there is a difference in door to balloon time goals between the 2 guidelines. I also found it interesting the point about opiates decreasing absorption of anti platelets early in an AMI. I have not seen in our ED that we give the loading dose ticagrelor or prasugral in ACS. Is there evidence to support it being given in ED, or is it just as effective to start within 24 hours? Thanks for the info, Joe.
Off the top of my head- I suspect the difference in timing pertains to consensus rather than evidence but will look into it further.
There isn't much difference between ticagrelor and prasugrel from the studies I've seen but what is important is early administration as early administration improves outcomes from PCI (as part of dual antiplatelet therapy- aspirin is still important!) so yes, early is better.
A little extra paper on the two agents- Almas T, Ehtesham M, Basit J, et al. Prasugrel versus ticagrelor for acute coronary syndrome patients undergoing percutaneous coronary intervention: A critical appraisal of randomized controlled trials. Ann Med Surg (Lond). 2022;74:103330. Published 2022 Feb 7. doi:10.1016/j.amsu.2022.103330
A nice quick refresh, really liked it 👍🏻
Good content! I like the comparison between the American and Australian guidelines. It would be interesting to know why there is a difference in door to balloon time goals between the 2 guidelines. I also found it interesting the point about opiates decreasing absorption of anti platelets early in an AMI. I have not seen in our ED that we give the loading dose ticagrelor or prasugral in ACS. Is there evidence to support it being given in ED, or is it just as effective to start within 24 hours? Thanks for the info, Joe.
Thanks Tara, appreciate the comment!
Off the top of my head- I suspect the difference in timing pertains to consensus rather than evidence but will look into it further.
There isn't much difference between ticagrelor and prasugrel from the studies I've seen but what is important is early administration as early administration improves outcomes from PCI (as part of dual antiplatelet therapy- aspirin is still important!) so yes, early is better.
A little extra paper on the two agents- Almas T, Ehtesham M, Basit J, et al. Prasugrel versus ticagrelor for acute coronary syndrome patients undergoing percutaneous coronary intervention: A critical appraisal of randomized controlled trials. Ann Med Surg (Lond). 2022;74:103330. Published 2022 Feb 7. doi:10.1016/j.amsu.2022.103330
Cheers, Joe